Psychiatry International

Background: Social media has become a space for sharing personal experiences and shaping public opinion. This study explored how people respond to substance misuse recovery journeys shared on TikTok. Methods: The researchers collected 3583 comments from 350 TikTok videos under the hashtags #wedorecover, #recovery, and #sobertok using a scraper tool. A discourse analysis categorized comments into Narrative Strategies, Rhetorical Strategies, Linguistic Features, and Power Relationships, each with subcategories revealing public perceptions of substance use and recovery. A correlation analysis was also conducted to examine the role of emojis across narrative and linguistic features. Results: Most comments (94%) expressed support or positivity toward recovery videos. The heart emoji was the most common (93.35% of all emojis), symbolizing connection, encouragement, and solidarity. Four themes emerged reflecting public attitudes: encouragement and positive messaging, acknowledgment of struggle, the culture of sharing, and the influence of broader social narratives. Conclusions: These results provide insight into public responses to recovery content on TikTok, suggesting that peer support may be facilitated through the platform’s algorithmic design. While TikTok shows promise as a supportive digital space, further research is needed to understand its broader implications for substance use recovery support. Full article

Background: Many workers in non-health settings interact with people with living experiences of mental ill-health but have little knowledge about the symptoms, the mental health system, or may hold stigmatising views. Aims: This study evaluated the impact of an online mental health course. It was hypothesised that an increase in mental health literacy would reduce stigmatising beliefs. Methods: Students were invited to complete an online survey pre- and post-course completion as part of a quasi-experimental study with a pre-test–post-test design. Questions were related to demographic data, knowledge on mental ill-health and mental health care, and beliefs towards mental illness. The independent sample t-test, Shapiro–Wilks test for normality, and a Mann–Whitney U-test were used to analyse the data. Results: This study found that there was a significant change, with a large effect size, in self-reported knowledge about mental health and the mental health system. There was a small but significant reduction in Belief Towards Mental Illness scores (rank-biserial correlation = 0.2). The results indicated improved perceptions of those with mental ill-health. Conclusions: A specialised online course can effectively educate the non-clinical community workforce and reduce the stigma associated with mental ill-health. This enables people to assist those experiencing mental health distress from a well-informed and less fearful position. Full article

Psychiatric illness during childhood and adolescence is a growing concern, placing increased pressure on psychiatric services. Reliance on an evidence-based assessment tool may facilitate the identification and management of symptoms and may facilitate accountability. The purposes for this study were to characterize the psychiatric symptoms of a sample of pediatric patients accessing outpatient psychiatry using the DSM Level 1 Cross-Cutting Measure (CCSM), compare patient and caregiver ratings (CCSM), and explore patients’ acceptability of using the CCSM. The sample consisted of 51 patients (mean age 14 years) and 46 caregivers (mean age 43 years). Patient and caregiver ratings suggested problems with sleep, inattention, depression, irritability/anger, and anxiety. The most common discordance concerned suicide ideation. Most patients (34 of 38) reported that the assessment tool was easy to complete. The CCSM may be a useful, evidence-based, standardized, transdiagnostic assessment tool aligned with the DSM-5 that can be used in a variety of mental health settings to identify symptoms, inform treatment planning, and track progress. Full article

Prolonged hospitalization contributes to a decline in physical function and immobilization. This narrative review aims to explore physical rehabilitation approaches that address the specific characteristics of physical dysfunction in patients with schizophrenia. A literature review was conducted following an electronic search of PubMed for English-language articles published between January 2014 and January 2025. Based on the findings, a framework was constructed to categorize symptoms and physical challenges into three domains: (1) movement disorders and obesity induced by antipsychotic medications, which alter motor performance and lead to compensatory movements; (2) negative symptoms and cognitive impairments, which promote sedentary behavior and result in dysphagia, dynapenia, sarcopenia, and frailty; and (3) accelerated brain aging and disuse syndrome by schizophrenia, which impair neuromotor and cognitive function and increases the risk of physical dependency. These interconnected factors emphasize the need for targeted physical rehabilitation to maintain independence and reduce the risk of hospitalization. This review proposes a multidisciplinary approach involving psychiatrists, physical therapists, and occupational therapists, along with individualized nutritional support, as essential components of comprehensive rehabilitation strategies aimed at improving physical outcomes and reducing early mortality in this population. Full article

Background: Dispelling myths is crucial for policy and health communication because misinformation can directly influence public behavior, undermine trust in institutions, and lead to harmful outcomes. This study aims to assess the effectiveness and differences between OpenAI’s ChatGPT and Google Gemini in dispelling myths about children’s and adolescents’ mental health. Methods: Using seven myths about mental health from the UNICEF & WHO Teacher’s Guide, ChatGPT-4o and Gemini were asked to “classify each sentence as a myth or a fact”. Responses of each LLM for word count, understandability, readability and accuracy were analyzed. Results: Both ChatGPT and Gemini correctly identified all 7 statements as myths. The average word count of ChatGPT’s responses was 60 ± 11 words, while Gemini’s responses averaged 60 ± 29 words, a statistically non-significant difference between the LLMs. The Flesch–Kincaid Grade Level averaged 11.7 ± 2.2 for ChatGPT and 10.2 ± 1.3 for Gemini, also a statistically non-significant difference. In terms of readability, both ChatGPT and Gemini’s answers were considered difficult to read, with all grades exceeding the 7th grade level. The findings should nonetheless be interpreted with caution due to the limited dataset. Conclusions: The study adds valuable insights into the strengths of ChatGPT and Gemini as helpful resources for people seeking medical information about children’s and adolescents’ mental health, although the content may not be as easily accessible to those below a college reading level. Full article

Treatment-resistant depression (TRD) affects 20–30% of patients with major depressive disorder and presents a significant clinical challenge due to its biological diversity. This review highlights standard mechanisms that contribute to treatment resistance beyond traditional monoaminergic models. Evidence supports serotonergic dysregulation, including 5-HT1A autoreceptor dysfunction and “serotonin flooding” as well as dopaminergic deficits linked to anhedonia and an imbalance between glutamate and GABA that impair synaptic plasticity. Changes in neurotrophic signaling, such as reduced BDNF and VEGF activity, complicate recovery by limiting neural repair and regeneration. Chronic inflammation and oxidative stress contribute to neuronal dysfunction, while HPA axis dysregulation may exacerbate depressive symptoms and resistance to antidepressants. Emerging evidence suggests that obesity and gut microbiota imbalance reduce the production of short-chain fatty acids by bacteria and increase intestinal permeability, thereby influencing neuroinflammatory and neurochemical processes in TRD. Neuroimaging studies reveal hyperconnectivity within the default mode network and impaired reward circuits, both of which are associated with persistent symptoms and a poor treatment response. By combining evidence on inflammation, oxidative stress, neuroendocrine disturbances, microbiome changes, and brain connectivity issues, this review develops a comprehensive framework for understanding TRD. It emphasizes the importance of biomarker-based subtyping to guide personalized future treatments. Full article

Background: Youth and young adults with early psychosis frequently use cannabis, yet the reliability of self-reported use is uncertain in clinical practice. We examined the concordance between self-reported cannabis use and urine toxicology among patients enrolled in an Early Psychosis Intervention (EPI) program in Southeast Ontario, Canada. Methods: We conducted a cross-sectional chart review of 116 EPI patients (2016–2019). Demographics, self-reported cannabis use (yes/no), concurrent substance use, and urine toxicology results from the initial clinical assessment were extracted. Diagnostic indices (sensitivity, specificity, positive/negative predictive values, and accuracy) were calculated using urine toxicology as the reference. The clinical panel used a 50 ng/mL threshold for THC-COOH; the specific assay platform (immunoassay vs. confirmatory GC-/LC-MS) was not specified in records and is noted as a limitation. Results: Overall, 82.8% (96/116) self-reported cannabis use. Self-report showed high sensitivity (88.4%) but very low specificity (20.3%), with PPV 39.2%, NPV 75.0%, and accuracy 45.30%, indicating limited concordance with urine toxicology. Self-reported cannabis use was significantly associated with self-reported cocaine and MDMA use, while associations with methamphetamine, opioids, and benzodiazepines were not significant. Conclusions: In this EPI cohort, self-reports overestimated cannabis use relative to urine toxicology (high sensitivity, low specificity, and accuracy <50%). These findings support cautious clinical interpretation of self-report and the complementary value of biological verification, especially when use is infrequent or the testing window/threshold may miss exposure. Future work should incorporate use frequency, potency, and timing relative to testing, and clearly specify toxicology assay methods. Full article

The increasing prevalence of Autism Spectrum Disorder (ASD) is a significant health concern influenced by both genetic and environmental factors. However, limited data exist on the socio-demographic and clinical characteristics associated with ASD in our region. This cross-sectional study assessed 200 children (155 boys and 45 girls) diagnosed with ASD at Hawler Psychiatric Hospital in Erbil city between January and December 2023. The Childhood Autism Rating Scale-Second Edition (CARS-2) was used for diagnosis and severity assessment. The mean age of participants was 4.6 ± 1.8 years, with males representing 77.5% of the sample. Cesarean section was the most common mode of delivery. The average parental ages were 34.8 years for mothers and 38.5 years for fathers. The first signs of autism were noticed at a mean age of 25.7 ± 9.7 months, with the first medical consultation at 34.6 ± 15.4 months and diagnosis at 42.4 ± 15.5 months. Delayed speech was the most common reason for seeking medical help. Statistically significant associations were found between severe autism symptoms and several factors, including older child age, younger age at first assessment, delayed speech, parental consanguinity, paternal age over 40, lower paternal education, and lower socioeconomic status. These findings emphasize the critical role of early detection and the influence of both socio-demographic and clinical factors on ASD symptom severity, highlighting the need for targeted early intervention strategies to improve outcomes in affected children. Full article

Background/Objectives: Subjective well-being (SWB) in children is a key indicator of healthy development, influenced by physical activity and sports, with physical literacy (PL) as a potential mediator. Traditional linear models overlook non-linear and heterogeneous effects in diverse populations. This study uses causal machine learning (ML) to examine PL’s mediating role between sports participation and SWB in a multinational cohort. Methods: Data from the International Survey of Children’s Well-Being (ISCWeB) (n = 128,184 children aged 6–14, 35 countries) were analyzed. SWB was a composite (six items, α = 0.85); PL was a proxy (three items excluding sports frequency, α = 0.70); sports participation was continuous (0–5). Confounders were age, gender, parental listening, and school satisfaction. CausalForestDML estimated the effects; GroupKFold and bootstrap were used for robustness; SHAP/PDP was used for interpretability. Results: Total ATE = 0.083 (95% CI [0.073, 0.094]); indirect via PL = 0.055 (CI [0.049, 0.061]); direct = 0.028 (CI [0.020, 0.038]); mediation proportion = 0.660. Sensitivity with lean PL (2 items) was as follows: indirect = 0.045 (CI [0.040, 0.050]). For SHAP, school satisfaction was (+0.28), and parents were (+0.20) top. For PDP, there was a non-linear rise at PL 4–6 (+1.2 units) and a plateau ~9.2. The cross-cultural mean ATE = 0.083 ± 0.01 (from within-country meta-analysis); this was stronger in older children (CATE 0.30 for 12–14). For Rho sensitivity at 0.1, it was indirect −0.129; at Rho sensitivity of 0.2, it was −0.314 (robust to low confounding). Conclusions: The findings, grounded in SDT/PYD, support interventions targeting PL through sports to enhance SWB, addressing inactivity. Limitations are its cross-sectional nature and proxy measures; we recommend longitudinal studies. Full article

N-Acetylaspartate (NAA) plays a critical role in neuronal function, metabolism, and neurotransmitter release. Evidence from magnetic resonance spectroscopy indicates diminished NAA levels in individuals diagnosed with schizophrenia and bipolar disorder; however, this process is time-consuming, expensive, and not viable in individuals with acute illness exacerbation. In order to address these limitations, we developed a novel method for the quantification of plasma NAA based on tandem mass spectrometry coupled to liquid chromatography (HPLC-MS). Our study aimed to assess whether plasma NAA levels change during hospitalization and whether these changes correlate with symptomatic improvement in patients experiencing acute psychiatric exacerbations. We recruited 31 inpatients with acute symptoms of psychotic (48.39%) and/or mood (51.61%) disorders. Symptom severity was assessed using the brief psychiatric rating scale, Positive and Negative Syndrome Scale, and Clinical Global Impression Scale. Plasma NAA was measured at admission and discharge. We observed a significant decrease in symptom scores and a significant increase in plasma NAA levels between admission and discharge. The initiation of therapy with lithium salts significantly influenced plasma NAA changes. Our study shows that our HPLC-MS method can detect clinically meaningful changes in plasma NAA levels. These results might lay the groundwork for future research exploring the relationship between plasma NAA levels and cerebral NAA levels measured by MRS. Full article

The Clinical Descriptions and Diagnostic Guidelines (CDDG) for Mental, Behavioral, and Neurodevelopmental Disorders (MBND) in the International Classification of Diseases 11th Revision (ICD-11) are a substantial improvement over their equivalent in the ICD-10. This study evaluates the usefulness of the synchronous and asynchronous modalities of an online training course on the ICD-11-CDDG-MBND to increase readiness to implement it in routine clinical practice among Spanish-speaking clinicians. A convenience sample of psychiatrists, psychologists, and general practitioners completed online evaluations of one of the two course modalities. Acquired knowledge was evaluated through a multiple-choice questionnaire. Readiness to implement the ICD-11-CDDG-MBND was evaluated before and after the course, using an instrument based on the transtheoretical model of stages of change: precontemplation, contemplation, preparation and action. A total of 310 clinicians completed either the asynchronous (n = 176) or synchronous course (n = 134). Prior to the course, most participants were at the precontemplation stage. By the end of the course, participants reported a moderate level of knowledge. The percentage of clinicians at the preparation and action stages was higher than before the courses, with no differences being observed between course modalities. Online training was associated with increased knowledge and motivation to implement the ICD-11-CDDG-MBND. Full article

Olanzapine and clozapine, two of the most efficacious second-generation antipsychotic drugs (SGAs), are known to cause serious metabolic side effects. Despite their clinical utility, the epigenetic basis of these metabolic side-effects remains poorly understood. This exploratory study investigated whether histone methylation is associated with metabolic disorders following chronic SGA treatment. Rats were treated with olanzapine or clozapine for 9 weeks and then sacrificed 2 h after the final treatment. After evaluating the metabolic parameters, Chromatin immunoprecipitation (ChIP)-deep sequencing was conducted on liver tissue pooled from twelve samples per group to quantify histone H3K4me2 methylation and transcriptional changes. Gene ontology term enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis were used to explore shared functional pathways of genes with differential histone methylation. Key findings revealed that both olanzapine and clozapine induced widespread changes in hepatic histone methylation, particularly hypermethylation at H3K4me2 across genes involved in lipid and glucose metabolism, insulin signalling, and adipogenesis. Olanzapine- and clozapine-treated rats displayed increased H3K4me2 levels at numerous gene loci and at distinct genomic regions. These findings suggest the importance of monitoring metabolic parameters in psychiatric patients and potential novel strategies to mitigate SGA-induced metabolic side effects. Full article

Background: Poisoning is a frequent cause of emergency department (ED) visits. The COVID-19 pandemic may have influenced its epidemiology and clinical profile. Objective: To analyze and compare the characteristics of poisonings treated in the ED before and after the COVID-19 pandemic. Methods: A retrospective observational study was conducted including all patients who attended for acute poisoning in a Spanish tertiary hospital from January 2018 to December 2022. Sociodemographic variables, toxic agents, clinical features, psychiatric history, intentionality, and outcomes were analyzed. Results: A total of 170 cases were recorded. Medicinal agents were the most frequent toxicants, followed by ethanol. After the onset of the pandemic, there was an increase in poisonings due to medicinal agents and in cases with psychiatric comorbidity, particularly intentional overdoses. Hospital admissions and ICU referrals also increased, although mortality remained low. Conclusions: The COVID-19 pandemic was associated with relevant changes in the epidemiology and clinical profile of poisonings treated in the ED, highlighting the growing importance of intentionality and psychiatric disorders. Full article

We tested the longitudinal invariance of seven short versions of the Center for Epidemiological Studies Depression Scale (CES-D) in maternal caregivers, following recent analytic recommendations for ordered categorical responses. Data for this study were drawn from the Longitudinal Studies in Child Abuse and Neglect (LONGSCAN) consortium, based on responses from 427 maternal caregivers across five waves corresponding to their children’s ages: 4, 6, 12, 14, and 16 years. We employed a comprehensive approach using differences in two approximate fit indices (CFI and RMSEA), the chi-square difference test (χ²), and a sensitivity analysis based on predicted response differences. Only one version demonstrated full invariance across all levels, while the others showed only partial evidence for loading or threshold invariance. These findings highlight concerns regarding the use of brief CES-D versions in longitudinal research, particularly over extended time periods. They also underscore the need to reassess whether item content aligns with current definitions of depressive syndrome. Our results suggest that evaluating the longitudinal invariance of short depression measures is essential to ensure the validity of conclusions about changes over time. Full article

The global prevalence of type 2 diabetes is alarmingly high, and a considerable proportion of diabetes patients suffer from anxiety and depression. The presence of anxiety and depression worsens the prognosis of diabetes; it increases non-compliance to the treatment and mortality rate. A cross-sectional study of adults ages 20 years or older was conducted in 24 districts of Khyber Pakhtunkhwa (KP). Individuals diagnosed by a certified medical doctor with type 2 diabetes were recruited using multistage stratified cluster sampling. The Agha Khan University Anxiety and Depression Scale (AKUADS) was used for assessment. Chi-square and logistic regression were used to assess the association between depressive disorder and characteristics of the study participants. The results showed that 31.64% of type 2 diabetic patients suffered from anxiety and depression. Prevalence was higher in individuals aged ≤40 years (37.75%), females (40.58%) compared to males (26.48%), individuals without formal education (38.48%), and underweight participants (55%). Anxiety and depression were also prevalent among housewives (38.04%), rural residents (34.76%), and current smokers (43.14%). Multivariate logistic regression indicated significantly higher odds of anxiety and depression among individuals with primary education (OR = 4.73, p-value = 0.03), underweight individuals (OR = 4.46, p-value = 0.001), and those reporting pain (OR = 2.82, p-value < 0.001). The high prevalence of anxiety and depression in the known diabetic population in the KP province of Pakistan requires the development of strategies for screening, awareness related to the contributing factors, and treatment of co-morbid depression at community level. Full article

Mental health issues and insufficient physical activity (PA) among students pose significant public health concerns. This study aimed to examine the prevalence of depression, anxiety, and stress symptoms, alongside PA levels, among Croatian medical students, with a focus on sex-specific differences and associations between these variables. A cross-sectional study was carried out during May and June 2025 among medical students at the University of Osijek, Croatia. Participants completed a self-reported questionnaire consisting of three sections: sociodemographic characteristics, the Depression, Anxiety, and Stress Scale-21 (DASS-21), and the International Physical Activity Questionnaire-Short Form (IPAQ-SF). The study included 244 students (70 males, 174 females) with a median age of 21 years (IQR: 20–23). Symptoms of depression, anxiety, and stress were reported by 33.1%, 48.4%, and 42.6% of participants, respectively. According to IPAQ-SF, 39.7% of students reported PA levels below current recommendations. Female students reported significantly higher depression (p = 0.009), anxiety (p < 0.001), and stress scores (p < 0.001), lower levels of moderate (p = 0.009) and vigorous PA (p < 0.001), and more time spent sitting (p = 0.006) compared to their male counterparts. Furthermore, significant positive correlations were identified between sitting time and depression (ρ = 0.17, p = 0.01), anxiety (ρ = 0.18, p = 0.006), and stress (ρ = 0.26, p < 0.001). Conversely, higher PA—particularly vigorous activity—was associated with lower levels of depression (ρ = −0.21, p = 0.001) and anxiety (ρ = −0.15, p = 0.018). Croatian medical students demonstrated a substantial prevalence of depression, anxiety, and stress symptoms, combined with inadequate levels of PA. These findings highlight the importance of implementing strategies aimed at supporting mental health and fostering regular PA among future healthcare professionals. Full article

This study investigated the impact of maternal psychological factors—specifically anxiety and depression—on breastfeeding outcomes in women with high-risk and low-risk pregnancies. A total of 157 postpartum women were assessed using the State-Trait Anxiety Inventory (STAI) and the Edinburgh Postnatal Depression Scale (EPDS) at multiple time points: 3–4 days, 3 months, and 6 months postpartum. Breastfeeding duration and exclusivity were the primary outcomes. Correlation analyses showed significant negative associations between STAI scores and breastfeeding duration in both groups, with stronger effects in the low-risk group (e.g., r = −0.546, p < 0.001 at 3 months). Similarly, EPDS scores were inversely correlated with breastfeeding duration, particularly at 3 and 6 months postpartum (r = −0.272, p < 0.001 and r = −0.248, p = 0.001, respectively, in the high-risk group). Logistic regression identified EPDS scores at 3 months (p = 0.046, Exp(B) = 0.844) and STAI scores at 3–4 days postpartum (p = 0.006, Exp(B) = 0.861) as significant predictors of early breastfeeding cessation. The model explained 64.9% of the variance in the low-risk group. These findings highlight the significant influence of postpartum anxiety and depressive symptoms on breastfeeding outcomes and suggest that early screening and support for these specific psychological factors may enhance breastfeeding duration and exclusivity, particularly after high-risk pregnancies. Full article

Background: Physical activity is essential for good health and human well-being, yet one-third of adults worldwide fail to achieve the recommended weekly physical activity. Buddhist Walking Meditation (BWM), Walking Meditation (WM), or Mindful Walking (MW) is a mindfulness practice characterized by mind–body interaction, seeking to promote people’s well-being. Therefore, this systematic review aimed to examine the effect of Buddhist Walking Meditation, Walking Meditation, or Mindful Walking on health in adults and older adults. Methods: This systematic review (PROSPERO: CRD42024581286) followed PRISMA guidelines. A literature search was conducted in PubMed, SciELO, Web of Science, and Scopus to identify studies that used BWM, WM, or MW as interventions in adults and older adults. The methodological quality was assessed using the PEDro scale, and the risk of bias was evaluated using the Cochrane RoB 2 tool. Results: Ten studies met the inclusion criteria, with intervention durations ranging from 4 to 24 weeks. Most were rated as “good” quality. Positive effects were reported in ankle proprioception, balance, functional fitness, psychological outcomes (e.g., reductions in stress, anxiety, or depression), and selected cardiometabolic markers (HbA1c, blood pressure, and arterial stiffness) in specific subgroups. However, several studies showed a moderate-to-high risk of bias. Conclusions: BWM, WM, and MW are safe and potentially effective PA strategies to enhance physical and mental health in adults and older adults. Their simplicity, low impact, and high adherence rates make them suitable for sedentary or clinically vulnerable populations. Full article

Background: Insomnia is strongly associated with stimulant use across various populations and for a wide range of substances. It represents a significant clinical problem among individuals with stimulant use disorders, yet treatment guidelines for this specific population are limited. This gap underscores the need for a systematic review to analyze the pharmacological and non-pharmacological treatments for insomnia in individuals with stimulant use disorders. The aim of this review is to determine the efficacy, safety, and limitations of these approaches and their impact on psychiatric symptoms, stimulant use, and adverse events. Methodology: A systematic review was conducted through January–July 2025 using PubMed, Scopus, and Web of Science. The review focused on the management of chronic insomnia associated with stimulant use, including substances such as amphetamines, methylphenidate, nicotine, caffeine, and cocaine. The systematic review was structured in accordance with the PRISMA guidelines, and identified studies were assessed by title/abstract and full-text evaluation. Results: A total of twenty studies were included in the systematic review. Seven studies examined pharmacological interventions, including modafinil, naltrexone/buprenorphine-naloxone, varenicline, combination NRT, and ramelteon. Thirteen studies investigated non-pharmacological approaches, including Cognitive Behavioral Therapy (CBT), Repetitive Transcranial Magnetic Stimulation (rTMS), Electrical Vestibular Nerve Stimulation (VeNS), maximal strength training, electroacupuncture (EA), and probiotics. The majority of interventions demonstrated positive outcomes in reducing insomnia severity, with some participants achieving non-clinical levels. Commonly reported clinical symptoms related to insomnia included difficulty initiating or maintaining sleep, early morning awakening, and sleep dissatisfaction. Conclusions: Both pharmacological and non-pharmacological interventions showed promise. However, the lack of validated guidelines underscores the need for integrated therapeutic approaches that address the complex comorbidity of insomnia, stimulant use, and co-occurring psychiatric conditions. Full article